paige_pharma said:

Steady state is the thing most people miss.

Bookmarking. The distinction being drawn above is the one nobody else makes. Printing the relevant bit and taking it with me.

Adding the clinical framing, because it changes how the question reads.

MASHdoc_SA said:

...but the FDA says semaglutide...

Interesting point. I want to add some regulatory nuance: the FDA labeling reflects the specific clinical trial data submitted for approval. Real-world clinical practice often extends beyond the FDA label based on emerging evidence and clinical judgment.

Example: semaglutide was first approved for diabetes (Ozempic), then obesity (Wegovy). The molecule didn't change — our understanding of its applications expanded. Similarly, semaglutide may evolve as more data accumulates.

Dr.PulmRoch said:

The mechanism that matters here is not stomach emptying, it is central.

Pushing back on Dr.PulmRoch here. The trial means are being read too generously in this thread. STEP populations were selected, supported, and titrated by protocol, and the real-world curves are consistently a few points worse. That difference is not noise, it is what happens when you remove the study infrastructure.

The figures, for anyone assembling their own picture. With resmetirom now available for MASH, combination approaches are being explored, so the standard of care in this area is moving faster than most threads assume.

Moderator note: leaving this open. It is being argued well and the disagreement is the useful part.